Chronic Obstructive Pulmonary Disease a Disease That Can Be Fatal if It Is Not Managed Well - Case Study Example

Acute Care of Nursing Name Institution Date Acute Care of Nursing Introduction The symptoms that are portrayed by Mr. Boyce are an indication that he is suffering from Chronic Obstructive Pulmonary Disease (COPD). The disease is preventable and treatable although significant extrapulmonury effects may contribute to the severity of the disease among the individuals (Nay, et al, 2013). Airflow limitation that is not reversible is one of its pulmonary components. The abnormal inflammatory response of the lungs to noxious particles or gases is usually responsible for the airflow limitations. It is also important to note that COPD may include a disease or a combination of disorders that causes airflow obstruction. According to statistics, about 2 million people in Australia suffer from COPD which is an indication that the disease is common in the country (Anzueto, 2013). However, in most cases it affects who smoke cigarettes or after exposed to dust and pollution. This is considering that Boyce who is showing symptoms of the disease is an elderly man was also a smoker. COPD is also considered as a major cause of hospitalization, premature death and disabilities in Australia. The paper thus discusses the concepts of COPD in relation to the condition of Boyce. Discussion Pathophysiology COPD is an obstructive lung disease that is characterized with inability to breathe out fully and poor airflows. Chronic incomplete reversible poor airflow is also one of the characteristics of the disease. Obstructive bronchiolitis and breakdown of the lung tissues is responsible for the poor airflow. The factors that contribute to the poor airflow may vary among different people. Large air pockets which replace the lung tissues are usually formed in severe cases due to the destruction of the small airways. The inhaled irritants usually results to chronic inflammatory and chronic bacterial infections may also contribute to the chronic inflammatory. The people who smoke have a high risk of developing COPD due to the Tc 1 lymphocyte (Brown, et al, 2012). Eosinophil involvement is also common among some people with COPD although eosinophil is common among the people with asthma. The chemotatic factors are also considered as inflammatory mediators and it contributes to the cell response. Free radicals in tobacco smoke contribute to oxidation stress which leads to damages to the lungs. The destruction of the connective tissues usually results to emphysema that contributes to poor airflow, poor absorption and release of respiratory gases. General muscle wasting also occurs in COPD and it is attributed to the inflammatory mediators that are released by the lungs into the blood. The inflammation of the airways also contributes to their narrowing and hence contributing to the difficulties in breathing. It is also important to note that the air reduction is always great when breathing out and hence resulting to the inability to breathe out fully (Vestbo, et al, 2011). The air trapping usually occurs when more air from the previous breathing remains in the lungs due to the inability to breathe out fully. The air trapping may lead to the lungs becoming full and hence contributing to shortness of breath. On the other hand, it may also be less comfortable to breath in when the air is already full in the lungs. The poor gas exchange may lead to low levels of oxygen in the blood and high levels of carbon dioxide (Farrell, et al, 2013). This may also lead to the reduced desire to breath and hyperinflation. The airway inflammation is usually increased during exacerbations which impacts negatively on the process of gas transfer. The narrowing of the arteries in the lung may also result to prolonged low levels of oxygen. Breakdown of capillaries in the lungs may also result from the inability to breath fully and hence resulting to increased blood pressure in the pulmonary arties. The increased blood pressure in the pulmonary arteries causes a condition known as Cor Pulmonale (Martinez, 2010). Oxygen therapy may be required incase of acute exacerbations. However, it is also important to note that the failure of taking into account the level of oxygen saturation in a person may lead to increased levels of carbon dioxide and hence impacting negatively on the individual. Oxygen therapy is not recommended for the people with high risk of carbon dioxide levels. On the other hand, the oxygen therapy is recommended for those without the risk of high carbon dioxide levels. Nursing problems associated with Mr. Boyce Care Actual problems in the next 24 hours Mr. Boyce’s ABGs indicated that he is mildly hypercapnic with compensated respiratory acidosis. He is also saturating at 90% on 2l via nasal prongs – 82% on room air. This is an indication that he will develop a problem with gas exchange in the next 24 hours. This will also be as a result of decreased ventilation from the airway obstruction. The gas exchange problem will also be as a result of low levels of oxygen and high levels of carbon dioxide in the blood. The main priority is therefore to provide supplemental oxygen for the purpose of preventing heart failure that may result to death within the next 24 hours. The main problem that needs to be prioritized in the next 24 hours is therefore the gas exchange problem which will require the SMART criteria in order to stabilize his condition. The specific focus for Boyce will be to undergo oxygen therapy. His saturation is 90% and it is always recommended that the patients who have a saturation of between 88-92% should undergo the oxygen therapy (Agustí, 2012). The low levels of oxygen at rest may result top heart failure which may in turn lead to death. The oxygen level of Boyce should be above 55mmHg by the end of the oxygen therapy. This will need to be confirmed through measurement and it will also form part of the measurable objective. The oxygen saturation should be above 90% after the oxygen therapy. A normal human being must have an oxygen saturation of between 95-100% (Estruch, 2014). Mr. Boyce oxygen level should be able to increase with the 24 hours. This will play an important role in reducing the amount of carbon dioxide. The reduction in the amount of carbon dioxide levels in the blood will be important in terms of ensuring that the gas exchange problem is solved (Taraseviciene‐Stewart, 2013). The reduction in the carbon dioxide level should be attainable for the purposes of ensuring that the gas exchange is within the normal range. The realistic objective will be to ensure that the physical and emotional condition of Mr. Boyce is improved. This is considering the condition may trigger stress and hence leading to emotional effects that may impact negatively on the recovery path. The time limit of reducing the levels of carbon dioxide within the blood will be 24 hours. This is because the problem will affect the patient within 24 hours. Prolonging the problem of gases exchange for more than 24 hours may lead to fatalities. It is also important to note that the process of prioritizing the nursing interventions plays an essential role in ensuring that the life of the patient is saved. The oxygen therapy may also play an important role in ensuring that other complications that may arise are reduced. The problem of gaseous exchange may also lead to other complication that may affect the breathing of the patient. The probability of intensive care will also be reduced by solving the problem of gaseous exchange. The success of the intervention will be determined by the oxygen saturation level. Problem that needs to addressed in the next 3 days The signs and symptoms indicate that Mr. Boyce will suffer from shortness of breath and its effects within 3 days. The shortness of breathe usually makes it difficult for the patients to breathe in since their lungs is partially full of air. On the other hand, Mr. Boyce may also start experiencing anxiety as results of shortness of breathe. The patients with shortness of breath may start getting worried due to the problem and hence causing anxieties (Anthonisen, 2011). This also impacts negatively on the quality of life the patients. The SMART criteria will also be used for the purposes of dealing with the situation facing the Mr. Boyce. The Specific objective will be to solve the problem of shortness of breath within the next three days of hospitalization of Mr. Boyce. During the hospitalization, palliative care will be provided together with noninvasive ventilation. Palliative care will play an important role in terms of reducing the symptoms (Kramer, 2011). On the other hand, the use of morphine will play an important role in ensuring that a feeling of relief is provided. The measurable objective is to ensure that Mr. Boyce is able to breathe normally within a period of three days. The reduction in the effects of shortage of breath will be the measurable objective for the patient. Mr. Boyce has to start experiencing relief in terms of breathing within the three days of hospitalization. On the other hand, the anxiety as a result of the shortness of breath should be completely eliminated within the 3 days of hospitalization. On the third day of hospitalization, Mr. Boyce will be able to demonstrate relief of anxiety and shortness of breathe. This will form the attainable objective of the expected outcome for the treatment of Mr. Boyce. On the other hand, it is also important to note that the objective is attainable and it will be important in terms of providing relief to the patient. This is considering that about 18% of the COPD patients with shortness of breathe usually die (Wadell, 2012). The realistic outcome that is expected will improve on the emotional and physical conditions of the patient. The time that is required to achieve the goals of reducing the shortage of breathe and its effects is three days. This is because Mr. Boyce is expected to undergo hospitalization for the period of at least 3 days. The nursing interventions are sufficient to ensure that each of the goals is achieved. The success of the evaluation will be determined through the carrying out clinical tests to determine the success rate. The evaluation process is important in ensuring that the nursing goals have been achieved. It is also important to note that the success rate of the goals will enable Mr. Boyce to be discharged and be out of any immediate danger from COPD. Further risk of readmission Mr. Boyce faces risk of readmission once he is discharged since his condition is chronic. However, nursing interventions can play an important role in minimizing the chances of readmission. The long term oxygen therapy is useful in terms of ensuring that the chances of readmission are minimized. This will also play an important role in ensuring that Mr. Boyce is able to deal with the potential problem of gaseous exchange and shortage of breath. However, it is also important to note that collaborative clinical care will be required for Mr. Boyce. This will involve different professionals as well as the family members. This is considering that Mr. Boyce is still living with his wife and their daughter frequently visits them. The family have to be taught how to deal assist Mr. Boyce to mange his condition and hence preventing the risk of readmission. The risk of readmission is usually high for the COPD patients depending with the environment that they live (Fabbri, 2011). In order to improve o the quality of life after being discharged, his nutrition diet should also be improved. Improved diet will play an essential role in term of preventing weight loss which is not good for the patients suffering from COPD. It is important to note that the body mass index is also dependant on the diet. An improved diet will have a positive outcome on the body mass index of Mr. Boyce. This is considering that the body mass index determines whether the patient should undergo surgery or not once they are readmitted. Supplemental nutrition should be provided to Mr. Boyce for the purposes of preventing malnutrition. A proper nutrition will also be important in terms of ensuring that his body is able to cope with the COPD as his condition can be considered chronic. The family members should also be informed of the diet that should be provide to him in order to improve on his quality of life. Incase of readmission, several alternatives to active medication should be considered. Exercise which involves pulmonary rehabilitation should be considered. This method is important in terms of increasing the muscle strength and improvement of COPD symptoms (MacNee, 2013). The ability of Mr. Boyce to improve on his condition and control the disease further can also be enhanced through the use of pulmonary rehabilitation. It is also important to note that the use of pulmonary exercise is important for patients who are underweight. Conclusion In conclusion, it is evident that COPD is a disease that can be fatal if it is not managed well. COPD affects the breathing of the patients and hence causing distress. Mr. Boyce is likely to face gaseous exchange problem within 24 hours of admission. Shortness in breath will also be experienced within the 3 days of admission. The intervention measures will involve the provision of oxygen therapy and palliative care. It is also evident that proper nutrition and exercise will be required since there are chances of readmission. References Nay, R. et al. (2013). Older people: Issues and innovations in care. Chatswood, A: Elsevier Science Pub. (chapter 7, person-centred care). Brown, D. et al. (2012). Lewis's medical-surgical nursing: Assessment and management of clinical problems. Chatswood, N.S.W: Elsevier Australia. Farrell, M. et al. (2013). Smeltzer and bare's textbook of medical-surgical nursing. Sydney: Lippincott Williams & Wilkins. Agustí, A. (2012). Persistent systemic inflammation is associated with poor clinical outcomes in COPD: a novel phenotype. PloS one, 7(5), e37483. Taraseviciene‐Stewart, L. (2013). 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